Prognostic value of ST2 biomarkers in hypertonic disease patients on the background of the chronic obstructive pulmonary disease

Introduction. Scientific research by domestic and foreign scientists and many years of clinical experience suggests that in patients with chronic obstructive pulmonary disease (COPD) a combination with arterial hypertension (AH) were often observed. Soluble form of ST2 protein of the patients is involved in certain inflammatory diseases and in the paracrine system of protection of the heart and lungs as marker, that determines the prognosis in patients with heart and lung deficiency and predicts the death of the patient during the year. The purpose of this study was to evaluate the expression of ST2 protein in patients with arterial hypertension on the background of chronic obstructive pulmonary disease. Materials and methods. In 23 patients were diagnosed arterial hypertension stage II and COPD stage II without clinically significant concomitant disease, with an average age 51.72 ± 1.22 years (49.33-54.09) (gender composition: 22 males and 1 female), the smoking status is comparable to COPD patients, 18 patients with AH of both sexes aged from 33 to 67 years (mean age 50.74 ± 1.49 years (47.81-53.76), male / female ratio 17 / 83%), stage II of the arterial hypertension with the level of I-III degree of hypertension, different cardiovascular risk, without adequate systematic antihypertensive therapy and 18 patients with COPD stage II, mean age 50.32 ± 0.99 years (48.22-52.16) (gender composition: 14 males and 4 females), duration of the disease 7.52 ± 1.14 years. 80% of active smokers, the index of bacon-years 17.23 ± 2.69 years, the harmful professional factors (industrial) indicated 23.53%. Participants expressed their willingness to be included in medical research. Research results. The obtained data indicate that the lowest level of expression of ST2 protein was detected in patients with hypertension without concomitant pathology – 21.05 ± 2.12 ng/mL, which is in 11.78% lower than in patients with COPD without concomitant pathology (23,53 ± 1.8 ng/mL). The highest expression ​​of ST2 protein were demonstrated in patients with comorbid pathology group with COPD on the background of AH – 33.01 ± 6.25 ng/mL, which is in 56.82% higher compared with patients with AH, and in 40.29% higher than analogous marker in patients with monopathology in the form of COPD. In the group of COPD patients with a high level of ST2 (more than 30 ng / ml), significantly more negatively controlled negative cardiovascular predictors, such as the presence of left ventricular hypertrophy (χ2 = 7.61 at p = 0.006) and sympathetic balance disturbances according to the LF / HF index (χ2 = 4.72 at p = 0.03) and ST2 elevation was reliably associated not only with extrapulmonary prognostic factors, but also with a decrease in FEV1 of less than 50% (χ2 = 5.45 at p = 0.02). Conclusions. Patients of the experimental group with comorbid pathology AH and COPD had the most significant increasing level of ST2 protein as unfavorable prognosis marker compared to the groups of patients without combination of this pathology

ФАРМАКОТЕРАПІЯ ЯК ПЕРВИННИЙ СУБ’ЄКТ ФОРМУВАННЯ КЛІНІЧНОГО МИСЛЕННЯ СУЧАСНОГО МАГІСТРА ФАРМАЦІЇ

The aim of the work – to determine the level of formation of clinical thinking in students of the 4th course of the pharmaceutical faculty of full-time education after the completion of the study of the clinical discipline of Pharmacotherapy with the basics of pharmacokinetics and development for the use in the educational process of new, improvement teaching methods that will contribute to the clinical thinking formation of a modern pharmacy master.The main body. A comparative estimation of absolute and qualitative success and the determination of the average score was made. The correlation between the peculiarities of teaching, the number of academic hours for practical classes and the degree of clinical thinking formation in pharmacists have been revealed.Conclusions. The analysis of the means used for teaching in different years shows that the decrease in the number of academic hours for practical classes had a negative tendency to academic performance among students of the pharmaceutical faculty. The introduction of modern teaching methods with the use of interactive methods located on online platforms and increasing the volume of independent work can improve the acquisition of students practical skills and contribute to the clinical thinking formation in the modern pharmacy master.Мета роботи – визначення рівня сформованості клінічного мислення у студентів 4-го курсу фармацевтичного факультету денної форми навчання після завершення вивчення клінічної дисципліни “Фармакотерапія з основами фармакокінетики” і розробка до використання в навчальному процесі нових, поліпшення та вдосконалення існуючих методів навчання, які сприятимуть формуванню клінічного мислення сучасного магістра фармації.Основна частина. Проведена порівняльна оцінка абсолютної та якісної успішності і визначення середнього бала. Виявлена кореляція між особливостями викладання, кількістю академічних годин для практичних занять та ступенем сформованості клінічного мислення у провізорів.Висновки. Проведений аналіз засобів, що були використані для викладання в різні роки, показує, що зменшення кількості академічних годин для практичних занять мало негативну тенденцію на показники академічної успішності серед студентів фармацевтичного факультету. Впровадження сучасних методів навчання із застосуванням інтерактивних методів, розташованих на онлайн-платформах, та збільшення обсягів самостійної роботи дозволяють покращити оволодіння студентами практичних навичок і сприяють формуванню клінічного мислення сучасного магістра фармації

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Цистатин С сироватки крові як маркер гломерулярного ураження нирок у хворих на хронічний гломерулонефрит зі збереженою функцією нирок

Improving of glomerular damage diagnostics in chronic glomerulonephritis (CGN) is an actual theme.Aim. To analyze indicators of glomerular kidney damage in CGN patients.Methods and results. We examined 81 patients with CGN and saved renal function to analyze indicators of glomerular kidney damage according to vivo morphological kidney study in CGN patients with and without arterial hypertension (AH) and relationship between serum cystatin C (CysC) and histological parameters.Conclusion. Patients with hypertension had more expressed indicators of glomerular damage than patients without hypertension. We demonstrated that serum cysC is a marker of glomerular kidney damage in patients with CGN. Усовершенствование диагностики поражения гломерулярного аппарата при хроническом гломерулонефрите (ХГН) остается актуальной проблемой. С целью анализа показателей гломерулярного поражения почек у больных ХГН с артериальной гипертензией (АГ) и без по данным прижизненного морфологического исследования почек и взаимосвязи между цистатином С (CysC) сыворотки крови и гистологическими показателями обследован 81 больной ХГН с сохраненной функцией почек. Установлено, что у пациентов с ХГН и АГ более выражены изменения гломерулярного аппарата, чем у пациентов с ХГН без АГ. Продемонстрировано, что cysC сыворотки крови является маркером гломерулярного поражения почек у больных с ХГН.Удосконалення діагностики ураження гломерулярного апарату при хронічному гломерулонефриті (ХГН) залишається вкрай актуальною проблемою. З метою аналізу показників гломерулярного ураження нирок у хворих ХГН з артеріальною гіпертензією (АГ) та без за даними прижиттєвого морфологічного дослідження нирок і взаємозв'язку між цистатином С (CysC) сироватки крові та гістологічними показниками обстежили 81 хворого на ХГН зі збереженою функцією нирок. Встановили, що хворі на ХГН з АГ мають виразніші гістологічні зміни гломерулярного апарату, ніж пацієнти з ХГН без АГ. Показали, що cysC сироватки крові є маркером гломерулярного ураження нирок у хворих на ХГН

Serum cystatin C as a marker of glomerular kidney damage in patients with chronic glomerulonephritis with saved renal function

Improving of glomerular damage diagnostics in chronic glomerulonephritis (CGN) is an actual theme. Aim. To analyze indicators of glomerular kidney damage in CGN patients. Methods and results. We examined 81 patients with CGN and saved renal function to analyze indicators of glomerular kidney damage according to vivo morphological kidney study in CGN patients with and without arterial hypertension (AH) and relationship between serum cystatin C (CysC) and histological parameters. Conclusion. Patients with hypertension had more expressed indicators of glomerular damage than patients without hypertension. We demonstrated that serum cysC is a marker of glomerular kidney damage in patients with CGN

Фармацевтична опіка як кінцева мета формування сучасного провізора

        The World Health Organization (WHO) has identified the current strategic direction of health care throughout the world as "Focus on the patient." Therefore, the pharmacist role in the healthcare system is changing - a pharmacist has a key role in public health.         Pharmacist provides assistance to the patient and guarantees that assistance is designed correctly, effective among all the available options, is safe and right for this patient. Due to this the approaches to teaching students are changed significantly, it is necessary to create the clinical thinking in future pharmacists.         The main objective in teaching pharmacotherapy and clinical pharmacy is training the pharmacist to have an adequate theoretical knowledge and practical skills to control the conduct of the most rational drug therapy in a concrete patient. Pharmacist must choose the appropriate therapy for a patient based on pharmacokinetics, pharmacodynamics, possible side effects and age, sex, presence of comorbidities of the patient.         Practical sessions conducted directly in the clinic, include this organizational structure:The preparatory phase (organization and setting teaching purposes and motivations, control the output level of knowledge - tests, oral theoretical questions);The basic phase (formation of professional skills and knowledge to identify general principles of clinical pharmacy, work near a bed, definition of clinical syndromes, define treatment plan, analysis of the tests results, solving typical tasks and tests).The final phase – control of the the final level of knowledge and skills (solving atypical problems, writing prescriptions).We provided a special sense to the independent work of students on the preparation and wrote recommendation "The efficacy and safety protocol of medicines". Particular attention is paid to the following sections:medication and allergy history;pharmacotherapy;assessment of possible interactions of drugs;selecting assess the efficacy and safety of pharmacotherapy;daily logs of the dynamic control to the pharmacotherapy efficacy and safety.The important stage in the formation of clinical thinking in students is educational practice. During the practical training students should be familiar with the basics of deontology and the ethics of communication with pharmacies visitors; acquire skills of medicinal history collecting.Students are expected to acquire skills of choosing the optimal OTC medicine for a concrete patient and use to practice the algorithm of the distribution patients who need and do not need doctor consultation.Thus, an integrated approach to the teaching of pharmacotherapy, clinical pharmacy, practical training in clinical pharmacy, promotes the formation of clinical thinking in students. Современное стратегическое направление  развития ВОЗ в корне изменяет роль провизора в системе здравоохранения. В связи с этим существенных изменений претерпевают подходы к обучению студентов, возникает острая необходимость в формировании у будущих провизоров клинического мышления. В процессе преподавания необходимо закрепить и углубить навыки системного анализа медико-биологических ситуаций, клинического мышления, формирование социальной и профессиональной мобильности студентов. Применение комплексного подхода в процессе преподавания фармакотерапии и клинической фармации, учебной практики по клинической фармации при сочетании аудиторной части с использованием интерактивных форм способствует актуализации системного анализа медико-биологических ситуаций, клинического мышления и формированию социальной и профессиональной мобильности у студентов. Сучасний стратегічний напрям розвитку ВООЗ докорінно змінює роль провізора в системі охорони здоров’я. У зв’язку з цим істотно змінюються підходи до навчання студентів, виникає гостра потреба формувати у майбутніх провізорів клінічне мислення. У процесі викладання необхідно закріпити та поглибити навички системного аналізу медико-біологічних ситуацій, клінічного мислення, виховання соціальної та професійної мобільності студентів. Застосування комплексного підходу у процесі викладання фармакотерапії та клінічної фармації, навчальної практики із клінічної фармації при поєднанні аудиторної частини з використанням інтерактивних форм сприяє актуалізації системного аналізу медико-біологічних ситуацій, клінічного мислення та формуванню соціальної та професіональної мобільності у студентів

Pharmaceutical care as the ultimate goal of the мodern pharmacist formation

The World Health Organization (WHO) has identified the current strategic direction of health care throughout the world as "Focus on the patient." Therefore, the pharmacist role in the healthcare system is changing - a pharmacist has a key role in public health. Pharmacist provides assistance to the patient and guarantees that assistance is designed correctly, effective among all the available options, is safe and right for this patient. Due to this the approaches to teaching students are changed significantly, it is necessary to create the clinical thinking in future pharmacists. The main objective in teaching pharmacotherapy and clinical pharmacy is training the pharmacist to have an adequate theoretical knowledge and practical skills to control the conduct of the most rational drug therapy in a concrete patient. Pharmacist must choose the appropriate therapy for a patient based on pharmacokinetics, pharmacodynamics, possible side effects and age, sex, presence of comorbidities of the patient. Practical sessions conducted directly in the clinic, include this organizational structure: The preparatory phase (organization and setting teaching purposes and motivations, control the output level of knowledge - tests, oral theoretical questions); The basic phase (formation of professional skills and knowledge to identify general principles of clinical pharmacy, work near a bed, definition of clinical syndromes, define treatment plan, analysis of the tests results, solving typical tasks and tests). The final phase – control of the the final level of knowledge and skills (solving atypical problems, writing prescriptions). We provided a special sense to the independent work of students on the preparation and wrote recommendation "The efficacy and safety protocol of medicines". Particular attention is paid to the following sections: medication and allergy history; pharmacotherapy; assessment of possible interactions of drugs; selecting assess the efficacy and safety of pharmacotherapy; daily logs of the dynamic control to the pharmacotherapy efficacy and safety. The important stage in the formation of clinical thinking in students is educational practice. During the practical training students should be familiar with the basics of deontology and the ethics of communication with pharmacies visitors; acquire skills of medicinal history collecting. Students are expected to acquire skills of choosing the optimal OTC medicine for a concrete patient and use to practice the algorithm of the distribution patients who need and do not need doctor consultation. Thus, an integrated approach to the teaching of pharmacotherapy, clinical pharmacy, practical training in clinical pharmacy, promotes the formation of clinical thinking in students